Typhoid vaccine
Typhoid is spread through contaminated food and water. It is one of the vaccines most often recommended for South Asia, and for anyone staying with family rather than in a hotel.
Typhoid fever is caused by Salmonella Typhi and spreads through food and water carrying the bacteria. It brings prolonged high fever, headache, abdominal pain and weakness, and it can become serious without treatment.
The part that matters for a traveller is that this is a food-and-water illness. You do not catch it from the air or from casual contact, which is why the vaccine is only half the strategy and the food and water half is not optional.
The risk is not evenly spread across travellers either. It is highest where sanitation is variable and where you are eating in homes and local establishments rather than in hotels, which is why visiting friends and relatives is consistently the highest-risk kind of trip.
Who should be offered the typhoid vaccine?
Canadian immunization guidance is fairly specific about this, and it is more specific than a country list.
Most travellers to South Asia
Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. Risk is highest for travel to India, Pakistan and Bangladesh.
Anyone staying longer than about two weeks
The data suggest most cases in travellers occur in people staying beyond two weeks, so length of stay changes the answer on its own.
Other destinations, weighed case by case
Parts of Africa, Southeast Asia and Central and South America are a judgement call, weighed against travelling with children, staying with friends and relatives rather than in hotels, longer trips with more exposure to local food and water, and your own preference.
People whose health raises the risk
Asplenia, including sickle cell anemia, and low stomach acid or the use of acid-suppressing medication all count towards it.
Household contacts of a chronic carrier
Ongoing or intimate household exposure to a known typhoid carrier is its own reason for immunization, separate from travel.
Two forms
Both are available in Canada: an injected inactivated vaccine and a live oral vaccine taken as capsules. Which one suits you depends on your age, your health, your timing and your preference, and the pharmacist will go through it during the consultation.
Injection
A single dose, one visit, done. It is the simpler option and it is the one used for children aged 2 to 4, in pregnancy, and for people who are immunocompromised.
Capsules
Four capsules taken on alternate days, kept refrigerated and dry. It avoids a needle and lasts longer between courses, but it depends on you finishing all four correctly and it carries restrictions the injection does not.
The two, side by side
- Injection from 2 years, capsules from 5 years
- One 0.5 mL injection, or 1 capsule every other day to a total of 4
- 14 days after the injection, or 7 days after the last capsule
- At least 14 days for the injection, about 2 weeks for the capsules
- Injection every 3 years, a new 4-capsule course every 7 years
- Injection: site tenderness or pain, fever, headache, malaise, muscle aches in 1 to 10 per cent. Capsules: abdominal pain, nausea, diarrhoea, vomiting, fever, headache, rash.
- About 50 per cent, for both forms
The restrictions on the capsules
The oral vaccine is a live vaccine, which brings rules the injection does not have. These are the ones that most often waste a course.
Not if you are immunocompromised
Nor during an acute gastrointestinal illness. The injection is the option in both cases.
Pregnancy
The injection is preferred. The oral vaccine is used only where the risk of infection is high and the injection is not available.
Antibiotic and antimalarial timing
Finish the capsules at least 3 days before starting, or start them at least 3 days after finishing, sulphonamides and other antibiotics active against S. Typhi, and most antimalarials. Chloroquine, mefloquine and atovaquone-proguanil are exceptions and do not interfere.
All four capsules, properly
The full course is what gives the protection, and the capsules need to be kept refrigerated and dry throughout.
When to book, working backwards from your flight
6 to 8 weeks out is comfortable
Room for typhoid plus anything else the destination calls for, including vaccines given as a series weeks apart.
2 to 3 weeks out still works for typhoid on its own
The injection needs its 14 days. The capsule course needs about a week of capsules and then 7 days after the last one.
Under 2 weeks, come in anyway
Typhoid vaccine given late still gives partial benefit as protection develops, and there is usually plenty else worth doing: food and water advice, a rehydration and standby plan, and any vaccines that act faster. We would rather see you three days before you fly than not at all.
Common questions
Do I need a typhoid vaccine?
It depends on where you are going, how long for, and how you are travelling. Most Canadian travellers to South Asia should be offered it, and it is commonly considered for parts of Africa and Latin America, particularly for people staying with family. The consultation is where that gets decided.
Injection or capsules, which is better?
Neither is better in general. The injection is a single dose, simpler, and the option for children aged 2 to 4, in pregnancy and for people who are immunocompromised. The capsules avoid a needle and last 7 years rather than 3, but the course has to be completed correctly and started well before you fly.
How effective is the typhoid vaccine?
About 50 per cent, for both the oral and the injected form. It reduces your risk substantially but does not eliminate it, and it protects against nothing else, so food and water precautions still apply.
How long does it last?
The injection needs a booster every 3 years if you remain at risk. The capsules need a repeat 4-dose course every 7 years.
How far ahead do I need it?
The injection needs at least 14 days before exposure, and the capsules about two weeks in total. Come in 6 to 8 weeks before departure if you can, because that leaves room for the other vaccines your trip may need.
Can I have it while pregnant or immunocompromised?
The injected vaccine is the option in both cases. It can be considered in pregnancy where travel indicates it, and may be given to people who are immunocompromised, though the response may be reduced. The live oral vaccine is contraindicated if you are immunocompromised and is avoided in pregnancy unless the risk is high and the injection is not available. Talk it through with the pharmacist.
Does the vaccine mean I can eat anything?
No. It reduces the risk but does not eliminate it, and it does nothing for the other things contaminated food and water carry. Keep to the food and water advice as well.
Is it covered?
Travel vaccines are generally not covered by Alberta Health, though many private and employer plans reimburse them. Call 403-930-5806 for current pricing before you book, and keep your receipt for your insurer.